19 Sep

Front End of Revenue Cycle Management

When analyzing the full Revenue Cycle, a lot of emphasis is spent on the back-office pieces of billing. However, there are some front office policies that, if put in place, will save rejections and denials on the back end.

It All Starts with Scheduling
Your scheduling department should be well versed on your practice. This starts with how long each visit type typically lasts (new patient vs. established patient vs. physical, etc.). Make sure your EHR has these times set up correctly per visit type. Perhaps only schedule new patients on certain days or for certain time blocks. The idea here is to minimize patient wait times. We want to maximize our schedule by ensuring our providers can see all their patients in a day – in a timely matter. When your provider gets behind, the whole office gets behind and patients lose their patience. Look at how your practice currently sets up its various visit types and see if there is a better way to stagger or group your visits.

Checking Eligibility
Some of the most common rejections and denials we see are for subscriber ID errors or insurance termed. These are easy issues to overcome. First, your EHR and clearinghouse may already have a solution where the system is set up to check patient eligibility 2-3 days prior to their appointment and kick back a report with patients who had eligibility issues. This allows a designated representative in your office to call the patient prior to their visit to get their insurance information correct in the system.
Perhaps your EHR or Clearinghouse does not offer an eligibility solution. You can do the same process manually. Print a visit schedule for 2-3 days ahead, and check eligibility on all new patients on your schedule. Most payors have an online portal where you can check basic eligibility (is the patient active?). If you are a specialist, or the patient is coming in for a procedure that some insurances do not regularly cover, it may be wise to call the insurance and speak with a benefits representative on the phone. Remember to get the representative’s name and a reference number for the call so your back office can use that information if needed!
For established patients, make it a part of your check in routine to have the front desk ask if the patient’s insurance has changed since their last visit. This will help catch mid-year changes. However, January 1, you should be checking eligibility for every patient on the schedule for the first 45 to 60 days of the new year.

Be Proactive about Your Co-Pay Collection
Gone are the days of the patient paying their co-pay on their way out the door. With high deductible plans and higher co-pays, it is best practice for a provider to take your patient’s co-pay at check in. Once a patient walks out of the office, your chance of collecting that co-pay reduces by 60%. Prevent the opportunity for a patient to leave without paying by making up front collections a standard policy in your office.
Front end rejections and denials are some of the easiest to conquer. Establishing new policies and procedures can help decrease your DSO (days sales outstanding) by ensuring more clean claims go out the door and pay during their first pass.

Donna White

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